Diffuse Myocardial Interstitial Fibrosis and Dysfunction in Early Chronic Kidney Disease

Area of Science:

• Cardiology
• Nephrology
• Biomedical Imaging

Background:

• Patients with chronic kidney disease (CKD) face elevated cardiovascular (CV) morbidity and mortality.
• Uremic cardiomyopathy (UC) is a suspected cause, potentially driven by myocardial fibrosis.
• The progression of myocardial changes in early-to-moderate CKD is not well understood.

Purpose of the Study:

• To longitudinally assess myocardial structure and function in patients with CKD.
• To investigate the progression of interstitial myocardial fibrosis in CKD.
• To evaluate changes in cardiac magnetic resonance imaging (CMR) parameters over time.

Main Methods:

• A longitudinal study involving 30 CKD patients and healthy controls.
• Cardiac MRI with T1 mapping and late gadolinium enhancement (LGE) was performed.
• Patients were followed for a mean of 2.7 years, with stable renal function.

Main Results:

• No significant changes in left ventricular mass, volumes, ejection fraction, native T1 times, or extracellular volume were observed in CKD patients or controls.
• Minor, clinically insignificant decreases in global longitudinal strain and mitral annular planar systolic excursion were noted in CKD patients.
• No new LGE was detected, and existing LGE remained stable.

Conclusions:

• In stable CKD patients, key cardiac structural and fibrosis markers (LV mass, T1 times, ECV) do not worsen over 2.7 years.
• This suggests that uremic cardiomyopathy may not exhibit rapid progression in terms of fibrosis in this patient group.
• Further research is needed to understand the long-term cardiac implications in CKD.